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2. Date:
   Date:
4. First Name*
5. Last Name*
7. Company Name
9. Mailing Address:*
11. City*
12. State*
13. Zip*
15. Email Address
16. Phone Number*
18. Preferred Manner of Written Communication:
20. Description of the Information Requested

    (Note:  Describe the information as precisely as you can.)

22. Date Range (optional):
23. From:
    From:
24. To:
    To:

26. Under the Public Information Act, some categories of information do not have to be released.  In most instances, a governmental body is required to request a decision from the Attorney General in order to withhold information from a requestor.  However, a requestor may permit a governmental body to redact information, without requesting an Attorney General decision.  You are not required to agree to the redaction of any information responsive to your request, but doing so may streamline the handling of your request.  

28. Do you agree to the redaction of confidential information provided such redactions are clearly labeled on the information you receive?
    -- Select One --YesNo
30. How would you like to have the information provided:
32. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
34. Electronic Signature
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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

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